Asthma is a long-term (chronic) condition where your child’s lungs can get irritated by being exposed to various triggers such as cold weather, pollen, etc. When this happens, the inside of the airways swell up, and produce more mucus and the muscles around the airways get tight making it difficult for you to breathe¹

Asthma often starts when kids are young, and it's more common in boys than girls. Kids with asthma face challenges like missed school days, lower academic achievement, bullying, inability to participate in sports, and dietary restrictions.^2,4

Fortunately, there are effective treatment options available to manage asthma symptoms and improve their quality of life.

Asthma is a common disease in children. Recent data shows that worldwide, around 9-10% of children between 6-14 years have asthma. The total burden of asthma in India is 34.3 million, accounting for 13.09% of the global burden.3 The occurrence rate is notably higher among boys and in urban areas.5 The number of children affected by this condition is going up over time.^4,6,7.

• Viral Infections: Pathogenic agents like viruses can cause infections in the lung passages. Viral infections can cause the airways to become inflamed, leading to wheezing and possibly developing into asthma.⁹
• Allergens & Irritants: Your child may have allergies to things like dust and pollen grains. Other factors include dust mites, pet dander, etc., which can trigger their symptoms. Certain environmental triggers, like air pollution, gases, strong odours from coils, cooking smells, sprays, or smoke, can irritate your child's airways and worsen their symptoms.
• Exercise: Physical activities (strenuous play or exercise) can sometimes cause wheezing, coughing, and a feeling of chest tightness in children with respiratory issues due to the narrowing of airways.
• Stress & Emotions: When your child feels stressed, it can cause shortness of breath and exacerbate their symptoms. ^1,4,10

• Viral infections can significantly impact both the development and exacerbation of asthma. Early and severe infections, such as those caused by respiratory syncytial virus (RSV) and rhinovirus (RV) are especially common and often cause bronchiolitis (infection/inflammation/swelling of the small airways), childhood wheezing, and asthma flare-ups. If your child gets viral infections a lot, it might increase the chances of them developing asthma.^9,18
• While many viral infections worsen asthma symptoms, RSV and rhinovirus are particularly notable for improving asthma risk. Infections from other viruses, including adenovirus, metapneumovirus, and bocavirus, can also exacerbate asthma.^19-21
• Having previous allergic reactions, i.e., food allergies.
• A family history of asthma or allergies.
• Living in areas with a lot of pollution.
• Being overweight.
• Having ongoing respiratory issues, such as rhinitis.
• Gastroesophageal reflux disease (GERD).
• Being a boy (chances of developing asthma is higher in males than females).
• Maternal obesity and weight gain during pregnancy heighten the likelihood of asthma in offspring.
• Being around tobacco smoke during pregnancy and childhood raises the risk of developing asthma.^4,11,12

Diagnosing asthma in children can be tricky, especially when they're young. Asthma symptoms can resemble those of other childhood illnesses, occasionally resulting in inaccurate or mistaken diagnoses.

To diagnose asthma, your child's doctor may use several methods:

In children <5 years of age, the doctor might recommend a trial of asthma medication for a minimum of 2-3 months to see if the symptoms improve.^{4, 13}

Patients with close family members, like a parent or sibling with asthma or allergies, are more likely to suffer from it.¹

To prevent asthma attacks, planning carefully and avoiding things that can trigger them is essential. Here are some tips:

• Reduce exposure to asthma triggers: Try to keep your child away from things that worsen asthma, such as allergens (house dust mite, furred pets, pest rodents, cockroaches, mold, and pollen) or irritants (car exhaust fumes, smoke, or strong smells).
• No smoking around your child: Tobacco smoke is a considerable risk for childhood asthma, so keep your child away from it.
• Encourage physical activity: If your child's asthma is well controlled, regular exercise can improve their lung function. Always consult a doctor to ensure the exercise routine is safe and suitable for your child's condition.
• Regular check-ups: See your child's doctor regularly. Don't ignore signs that their asthma might not be well controlled.
• Treatment as prescribed: Adherence to doctor-prescribed medications.
• Maintaining a healthy weight: Being overweight can exacerbate asthma and lead to additional health issues. Regular monitoring is essential.⁴

How doctors handle your child's asthma at the beginning depends on how bad it is.

The main goal is to keep the symptoms in check, which means your child should have

• To attain effective symptom management and sustain regular activity levels
• To mitigate future risks
• To decrease the likelihood of exacerbations
• To preserve lung function and promote optimal lung development
• To minimize adverse effects of medication.⁴

Treating asthma involves two main steps: stopping symptoms from occurring and dealing with asthma attacks if they do occur.

The type of medicine your child needs depends on their age, what symptoms they have, what triggers their asthma, and what works best to keep them in check.¹⁵

Asthma medications fall into two categories: Maintenance and reliever medications.

These must be taken regularly, regardless of symptoms, to prevent and control symptoms, reduce airway inflammation, and decrease the risk of exacerbations. Inhaled corticosteroids (ICS) are the most commonly prescribed maintenance medications. They reduce chronic inflammation and prevent airway narrowing and shortness of breath. They are taken particularly by inhalation and can be used to treat mild to severe asthma. If asthma isn't well controlled with these, the dose can be increased or combined with other medications. Overall, ICS are safe and should be reviewed on how well it's working as the symptoms of children can change over time to time and need to be checked and adjusted to manage asthma effectively.

Also known as rescue medications, these are fast-acting medications used as needed to relieve acute symptoms. They provide quick relief during asthma flare-ups and helps in reducing breathing difficulties during exercise. Reducing the need for reliever medications is a key goal in asthma management. Using your reliever more than twice a week indicates poor asthma control. In such cases, long-term controller medications should be taken regularly to address the underlying airway inflammation.^13,14,16

Very few children are treated for asthma due to associated stigma, leading to delays until their symptoms become intolerable.8 Severe symptoms may necessitate emergency care or hospitalization. In the most extreme cases, asthma can be life-threatening.¹

With the proper treatment, you can help your child control their symptoms and protect their growing lungs.

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